Lung cancer

Question 1

Define

Answer 1

DEFINITION: primary malignant neoplasm of the lung

WHO classification of bronchocarcinoma:

• Small Cell Lung Cancer - 20%
• Non-Small Cell Lung Cancer - 80%

Question 2

Risk factors

Answer 2

Smoking

Asbestos exposure

Other occupational exposure: polycyclic hydrocarbons, nickel, radon

Atmospheric pollution

Question 3

Epidemiology

Answer 3

Most common FATAL cancer in the west (18% of cancer mortality worldwide)

3 x more common in MALES

Question 4

Symptoms

Answer 4

May be ASYMPTOMATIC

Symptoms due to primary

• Cough
• Haemoptysis
• Chest pain
• Recurrent pneumonia

Symptoms due to local invasion

• Brachial plexus invasion –> shoulder/arm pain
• Left recurrent laryngeal nerve invasion –> hoarse voice and bovine cough
• Dysphagia
• Arrhythmias
• Horner’s syndrome

Symptoms due to metastatic disease or paraneoplastic phenomenon

• Weight loss
• Fatigue
• Fractures
• Bone pain

Question 5

Signs

Answer 5

May be NO SIGNS

Fixed monophonic wheeze (suggesting that there is a single obstruction)

Signs of lobar collapse or pleural effusion

Signs of metastases (e.g. supraclavicular lymphadenopathy or hepatomegaly)

Question 6

Investigations

Answer 6

CXR

• Sputum cytology
• Bronchoscopy with brushings or biopsy
• CT/US-guided percutaneous biopsy
• Lymph node biopsy

Staging - requires CT/MRI of head, chest and abdomen. PET scans may also be useful

Bloods

• FBC
• U&Es
• Calcium (hypercalcaemia is a common feature)
• ALP (raised with bone metastases)
• LFTs

Pre-Op - ABG and pulmonary function tests